269 Mocks Church Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor t ewa a Disposal System - G.S. Chapter 130-Article 13C)
OWNER ORC TOR DATE ; ;fl ; f ?y' PERMIT
91
LOCATI ", d/�
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME tj BUSINESS ❑
House. Trailer 800 Gala 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 80 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 00 Ga 900 Sq. Ft.
AUTO. DISHWASHER , YES 0' NO ❑ Four Bedroom House 100 Gal. 1200 Sq. Ft'.
AUTO. WASH. MACHINE YES [0` NO ❑
SITE SUITABLE YES V' NO ❑ /
SIZE OF TANK t?J gal.
NITRIFICATION FIELD �V�sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY �`,n: c.. INSTALLED BY
CERTIFICATE OF COMPLETION By Dat
w
(8/16/73) *Construction mu comply with all other applicable State and to re ula ions
LOT`AREA
ti